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5 Neurological Dysfunction > Midterm Practical > Flashcards

Midterm Practical Flashcards

1
Q

Alignment cues

A

emphasizes achieving neutral trunk position in initial conditions

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2
Q

Directional Cues

A

motor responses influenced by stimulation of superficial somatosensory inputs gently guiding the patient in the direction of desired movement

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3
Q

Loading Cues

A

goal is to increase somatosensory input by a force through joint into the ground, recreating the GRF

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4
Q

Approximation Cues

A

Increasing somatosensory input by applying a gentle force through the long axis of the bone into the proximal joint to increase activity in the proximal muscles

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5
Q

Resistance Cues

A

manual application of force away from the axis of motion at the joints as patient is asked to move or to stabilize

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6
Q

Pelvic alignment cueing

A

goal is to facilitate lumbar extension and anterior pelvic tilt

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7
Q

Upright trunk alignment cueing

A

goal is to facilitate thoracic extension

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8
Q

Directional cueing for weight shift and scooting

A

goal is to offload one half of the pelvis to allow for shifting forward of that side

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9
Q

Directional cueing for lateral weight shift in standing

A

goal is to shift weight onto stance limb and offload opposite limb for gait/stepping/etc

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10
Q

Approximation cueing for foot placement in seated

A

goal is to engage the patient is actively offloading the distal extremity in seated for limb respositioning

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11
Q

Loading cueing for the lower extremity

A

goal is to increase muscle activity through the lower extremity in weight bearing tasks

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12
Q

MMT Rating 5

A

pt has full ROM against effects of gravity. examiner provides maximal resistance with no discernible difference between affected and unaffected limbs

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13
Q

MMT Grade 4

A

patient has full ROM against effects of gravity. examiner provides strong resistance with slight difference noted between affected and unaffected limbs

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14
Q

MMT Grade 3

A

Patient has full ROM against effects of gravity, but is unable to sustain any resistance offered by examiner

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15
Q

MMT Grade 2

A

Gravity eliminated: patient is able to produce full AROM

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16
Q

MMT Grade 1

A

gravity eliminated: patient is unable to produce full AROM, but muscle tension is palpable

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17
Q

MMT Grade 0

A

gravity eliminated: patient unable to initiate AAROM and muscle tension is not palpable

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18
Q

C5 Nerve Root

A

Elbow flexion
Shoulder Abduction

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19
Q

C6 Nerve Root

A

Wrist Extension

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20
Q

C7 Nerve Root

A

Elbow extension

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21
Q

C8 Nerve Root

A

Finger flexion

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22
Q

T1 Nerve Root

A

Finger abduction

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23
Q

L2 Nerve Root

A

hip flexion

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24
Q

L3 Nerve Root

A

knee extension

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25
Q

L4 Nerve Root

A

ankle dorsiflexion

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26
Q

L5 Nerve Root

A

great toe extension

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27
Q

S1 Nerve Root

A

ankle plantar flexion

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28
Q

What is muscle tone?

A

the amount of inherent neuromuscular activity present even in a resting muscle and is detected y the response, specifically the amount of resistance, to passive elongation or stretch of the muscle being tested

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29
Q

Hypertonia

A

an increase in muscle tone that results from damage to the corticospinal tract in the cortex, brainstem, or spinal cord. Clinician will feel more ressitance than you would expect normally

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30
Q

Hypotonia

A

a decrease in muscle tone that results from damage to the lower motor neuron
Clinician will feel less resistance than you would expect normally

31
Q

Rigidity

A

an increase in muscle tone caused by damage to extrapyramidal motor structures

32
Q

Spasticity

A

an increased resistance to passive stretch taht is velocity dependent that is often seen in conjunction with hypertonia and indicates an UMN lesions. The faster movement increases the resistance to the stretch due to an uninhibited monosynaptic stretch reflex

33
Q

Grade 0 Spasticity

A

no increase in muscle tone

34
Q

Grade 1 Spasticity

A

slight increase in muscle tone, manifested by a catch and release or by minimal resistance but only at the end of the ROM when the affected part is moved in flexion or extension

35
Q

Grade 1+ Spasticity

A

slight increase in muscle tone, manifested by a catch, followed by minimal resistance detected throughout the remainder of the ROM

36
Q

Grade 2 Spasticity

A

more marked increase in muscle tone detected through most of the ROM but affected parts are easily moved

37
Q

Grade 3 Spasticity

A

Considerable increase muscle tone, passive movement difficult

38
Q

Grade 4 Spasticity

A

Affected parts rigid in flexion and extension

39
Q

Procedures for Sensory Exam

A

Patient lies in supine
Both right and left sides are tested for each site
All sites are tested for light touch and pin prick

Score = 0 for absent, 1 for altered, 2 for normal

40
Q

Cervical Sensory Testing Areas

A

C2 = behind the ear/lateral to occipital protuberence
C3 = in supraclavicular folssa
C4 = Over the AC joint
C5 = on the lateral side of antecubital fossa just proximal to the elbow
C6= dorsal surface of proximal phalanx of thumb
C7 = dorsal surface of proximal phalanx of middle finger
C8 = dorsal surface of proximal phalanx of little finger

41
Q

Thoracic Sensory Testing Areas

A

T1 = on the medial side of antecumbital fossa
T2 = at the apex of axilla
T3 = third rib intercostal space
T4 = fourth intercostal space (level of nipples)
T5 = fifth intercostal space
T6 = sixth intercostal space, xiphoid
T7 = slightly below seventh intercostal space
T8 = halfway between xiphoid and bellybutton
T9 = slightly above belly button
T10 = belly button line
T11 = between belly button and inguinal ligament
T12 = inguinal ligament

42
Q

Lumbar Sensory Testing Areas

A

L1 = midway between T12 and L2
L2 = mid femur
L3 = medial femoral condyle above knee
L4 = over medial malleolus
L5 = on dorsum of foot at third metatarsal phalangeal joint

43
Q

Sacral Sensory Testing Areas

A

S1 = on lateral aspect of calcaneus
S2 = at midpoint of popliteal fossa
S3 = over ischial tuberosity
S4/5 = perianal area

44
Q

Classification of SCI

A
  1. Determine the sensory level for R and L sides
  2. Determine motor levels for R and L sides
  3. Determine neurological level of injury
  4. Determine if the injury is complete or incomplete
  5. Determine the ASIA impairment scale grade
45
Q

C1-C3 Level of Injury

A

Muscles: SCM, paraspinals, neck
Bed Mobility: total assist
Transfer: Total assist
Standing: none
Wheelchair: need power

46
Q

C4 Level of Injury

A

Muscles: C3 + upper traps, diaphragm
Bed Mobility: Total
Transfers: Total
w/c: power
Standing: none

47
Q

C5 Level of Injury

A

Muscles: C3-C4, deltoid, biceps, brachialis, bracioradialis, rhomboids, some serratus
Bed mobility: some assist
Transfers: total
w/c: power or manual (needs assist)
standing: no functional

48
Q

C6 Level of Injury

A

Muscles: C3-C5, ECRL, ECRB, Serratus, Lats
Bed mobility: some assist
Transfers: Some assist
w/c: power or manual
standing: no functional

49
Q

C7-C8 Level of Injury

A

Muscles: C3-C6, pecs, triceps, pronator, ECU, FCR, finger flexors
Bed mobility: independent to some assist
Transfers: Independent to some assist
w/c: independent w/manual
standing: no functional

50
Q

T1-T9 Level of Injury

A

Muscles: C3-C8, hand intrinsics, intercostals, erector spinae
Bed mobility: independent
Transfers: independent
w/c: independent
standing: typically not functional

51
Q

T10-L1 level of injury

A

muscles: everything above and abs
bed mobility: independent
transfers: independent
w/c: independent
standing: walker and orthoses

52
Q

L2-S5 Level of Injury

A

muscles: everything above plus full abs, and partially to full LE
bed mobility, transfers, standing: independent

53
Q

High lesions and cough

A

muscles of inspiration and force expiration are affected

54
Q

Lower lesions and cough

A

will have intact muscles of inspiration, muscles of forced expiration will be impaired

55
Q

Functional Cough

A

of coughs per exhalation: 2 or more

Sounds loud and forceful
2 or more coughs per exhalation
functional significance: can clear secretion

56
Q

Weak functional cough

A

sounds soft and not forceful
one cough per exhalation
assistance needed to clear large amounts of secretions

57
Q

Nonfunctional cough

A

sounds like a sigh or throat clearing
no true coughs per exhalation
assistance needed for airway clearance

58
Q

Abdominal Thrust for coughs

A
  1. place hand in flat fist at least 1-2 inches below the xiphoids process, centered on abdomen
  2. Have patient inhale/exhale twice, then apply firm upward pressure on third exhale
59
Q

Modifications for Abdominal Thrust

A
  1. Anterior chest wall compression. One arm goes on chest at nipple line, second at umbilicus
  2. seated position for quicker resolution of congestion. Wide w squeeze in and push up
60
Q

Sidelying Rotation Cough assistance

A
  1. Position pt in sidelying with supports as mecessary
  2. Explain that you will be providing pressure while pt tries to cough on third exhale
  3. stand behind pt, with one hand on AC joint and other on hip
  4. provide a side compression and rotation pressure with third exhale
61
Q

Dose of Pressure Relief

A

Frequency = every 20 min
Duration = 30-90 sec

62
Q

C2-C5 Level of Injury Pressure Relief

A

anterior trunk lean

63
Q

C6 Level of Injury Pressure Relief

A

lateral trunk lean

64
Q

C7-C8 Level of Injury Pressure Relief

A

cross and trunk lean

65
Q

T1-T9 Level of Injury Pressure Relief

A

Lifting with triceps

66
Q

T10-L1 Level of Injury Pressure Relief

A

stand/squat

67
Q

Complete SCI Bed Mobility Techniques

A

Rolling
Supine to sit w/equipment
Supine to sit w/out equipment
Long sit

68
Q

Complete SCI Rolling

A

They need at least triceps to perform

to decrease difficulty, cross legs or have them 3/4 sidelying

to increase difficulty, uncross legs, increase incline

69
Q

Supine to sit (w/out equipment) for complete SCI

A

does not require triceps, uses shoulder protraction. Does require ROM of upper and lower body

  1. Start prone on elbows. The elbows are walked to the side until trunk is about perpendicular with hips
  2. Use hands to crawl farther, and then hook one arm under closest leg.
  3. Use other arm to push up into sitting position
70
Q

Long sit for complete SCI

A

passive tension of the hamstrings to avoid falling
elbows go into extension, with wrists extended, fingers curled. Maintains tendonesis grip

71
Q

Wheelchair transfers for those with SCI complete

A

Short sit
Sit pivot using head hips principle
Transfer board

72
Q

Stretches for Shoulder maintenance

A

Behind the chair
Cross arm
upper triceps

73
Q

Active movements for shoulder maintenance

A

Full can
ER
scapular squeeze
cross body

74
Q

Resistance for shoulder maintenance

A

full can with weight
ER with band attached to door
shoulder squeeze, band attached ahead
cross body pull downs

5 Neurological Dysfunction (16 decks)

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